The Doctor will see you now, but his sonic screwdriver will be taxed as a medical device…

There was a recent survey performed by the Doctor Patient Medical Association Foundation. Basically, they obtained 36,000 physician office fax numbers, delivered ~16,000 faxes and received ~700 replies. Their respondents were mostly private practice physicians, and mostly mid-career.

The results can be found here.


Here were some take home points from the survey (quoted from the results):

Many of these things are things that Dr. J. has discussed here at the website. The two most critical components of the doctor/patient relationship are the doctor and the patient. Unfortunately, over time, third party payers, be they government or private insurance have had a growing voice at the table. Why? Well, they’re footing most of the bill, to be perfectly frank, and we, collectively let them. Since the 1980s, we have been beguiled by low co-pays and low deductibles. We are told that health-care is a ‘right’ rather than a commodity or service rendered. As a consequence, we don’t think twice about going to the doctor’s office, spending pooled dollars, and driving up costs. Given the bidding process for services rendered, no one knows how much insured procedures really cost. An institution will have one price for ‘cash pay’ and lower, negotiated discount prices for private insurance, and even lower prices for Medicare/Medicaid patients. 


Dr. J. has held that the solution is the exact opposite of what the guv’mint is pushing with regulation and legislation. 


Think about what areas of medicine have had lower costs in the last decade. 


First, the Walmart $4 formulary. This made people clamor for generics as opposed to revile them. Dr. J. has had plenty of patients say, “work with me on this doc.” Furthermore, supermarkets, and Target have gotten into the act with free lisinopril and antibiotics. 


Second, the Doc-in-the-Box. Walk in clinics with prices posted on the wall have also lowered costs. Dr. J. hasn’t used one, per se, but he imagines you probably have to file your own insurance for many of them, and the prices they charge are less than what his insurance is charged by his internist, or his kids pediatricians.  


Third, (are you listening, Sandra?) uncovered treatments such as birth control, sterilization and so-called reproductive services. By paying cash, rather than having these services covered by insurance has made them less expensive than they will be when, paradoxically, they are free. The reason is that you, as the consumer, aren’t going to shop that vasectomy around, or find out which OCPs provide the best bang for your buck. Thank you, Institute of Medicine for driving up health care costs. 


Dr. J. prays that Obama-care is struck down in its entirety  by the Supreme Court this week. He doubts that will be the case, knowing his luck, but if it is, it gives us the opportunity to revisit this debate on where to go from here. If they do not, conservatives should go, “all repeal, all the time” until President Romney and a bicameral Republican legislature are forced to acquiesce to the will of the people and harpoon this leviathan. 

Dr. J.